It is precisely noon on Thursday, April 26th, and more than 30 men and women have gathered in a room in East Memphis to eat lunch and stare at women's breasts.
No, it's not what you think.
This is the Multidisciplinary Breast Conference, which meets weekly in a large meeting room at Baptist Memorial Hospital for Women. The surgeons, oncologists, nurses, and other specialists are gathered here to review particularly challenging cases of breast cancer. As a radiologist flashes CT scans and MR images of cancerous breast tissue on a wall, using a laser pointer to indicate problem areas, the experts discuss each patient, ponder various options for treatment, and then reach a conclusion. On this particular day, three cases are being reviewed, and across town, across the state, or sometimes across the country, each of these women sits nervously by the phone, waiting for her doctor to say what the group decided — a call that could mean the difference between life and death.
Think about this for a moment. At a time when health costs are spiraling, doctors are seeing more patients than they can handle, and insurance companies are clamping down on procedures, more than 30 medical experts — at today's meeting there's even a geneticist, since some forms of cancer can run in families — have spent more than an hour of their time to discuss just three patients.
Anita Vaughn, for one, knows how remarkable this is. "It's like getting three, four, five — you name it — second opinions," she says, "and there is no cost to the patient, so insurance companies love it." Just a few months before, the Today show featured a New York City hospital that was doing something similar. Vaughn shakes her head and smiles: "They acted like it was very unusual, but we've been doing this for five years now."
Vaughn is the CEO and administrator of Baptist Women's Hospital, and the weekly breast conference is just one of many things that makes this gleaming new facility at the corner of Walnut Grove Road and Humphreys Boulevard a very special place.
Leaving the Mother Ship
a hospital devoted to the unique needs of women had been discussed more than 15 years ago, but the Baptist Memorial Hospital board of directors didn't think it was a good idea. As Vaughn explains it, the OB/GYN doctors were the ones most opposed to it: "They said that we needed to stay with the 'mother ship,' so we would have all that support around us."
Every few years, the idea would be brought up and then dismissed. But in 1998, when Baptist was preparing a master plan for its growing campus on Walnut Grove, a women's hospital suddenly seemed like a good fit, and the board agreed.
"Women today are the health-care CEOs of their family, making some 80 percent of the health-care decisions," explains Vaughn. "I make them for myself, and I'm the one who schedules appointments for my husband, my children, even my parents. We realized that if you put your emphasis on women — making them the educated health-care decision-makers — then you are going to improve the health status of the entire community."
But what about the doctors who resisted the idea? "What finally convinced our OB/GYNs was when we said, we are not just moving our birthing center," says Vaughn. "We are opening up a full-service hospital, and it will have everything we need."
The new facility, designed by the Nashville architectural firm of Earl Swensson and Associates, took 18 months to plan, and another 18 months to build. On May 20, 2001, the $71 million complex began accepting its first patients. The place has seen quite a lot of activity since then: more than 5,200 births and more than 33,000 mammograms every year. And though everyone seems to think that a woman's hospital is part of every community's medical center, the Baptist Women's Hospital is actually quite unusual. It's one of just 16 free-standing women's hospitals in the entire country. The only other one in Tennessee is in Knoxville.
Since it opened, Vaughn is proud of the fact that they have had to make very few changes from the original plans. And the facility was designed for expansion. Two additional operating rooms and the entire fifth floor are just "shelled in," ready to be opened when needed.
On a recent tour of the hospital, it's easy to see why patients feel comfortable here. The lobby, with its cool marble floors, walls of windows, and soaring ceiling, feels calm and inviting. On this day, a children's art show is on display beside the quietly splashing fountain. A vine theme runs throughout the main floors, with leaves and tendrils etched into glass panels and elevator doors, painted on the walls, and printed onto wallpaper. (Even the hospital's restaurant is called The Vines Café.) Brightly colored handmade quilts line the corridors, donated by local quilting guilds. Thirty of them celebrate the first babies born here, while more than 50 others serve as memorials to cancer patients.
At first glance, the spacious patient rooms (left), painted in muted colors, resemble those in a first-class hotel. Sure, there's a high-tech hospital bed in the room, but an expensive armoire hides the TV and DVD player, a picture window looks out onto Humphreys Boulevard and the Wolf River beyond, and medical equipment and monitors are concealed behind wooden panels.
Despite appearances, this is certainly no resort hotel. The women's hospital offers many of the same medical services as what Vaughn calls "the Big House" just to the west — Baptist Memorial Hospital Memphis. But two areas really make the Women's Hospital stand out: its Comprehensive Breast Center and its Newborn Intensive Care Unit.
A Patient's Best Friend
Pam Winter is a registered nurse and one of three breast health specialists at Baptist Women's Hospital. She plays a rather special role — to be the "best friend," as she puts it, for any woman who is being diagnosed or treated for breast cancer.
A woman is usually sent to the hospital for further testing after she discovers a lump or a diagnostic mammogram indicates something suspicious. The next step is usually a core-needle biopsy, when breast tissue is extracted and examined for cancerous cells. It's a nerve-wracking procedure; if cancer is found, the next step is chemotherapy, radiation, surgery, or a combination of all three.
That's where Winter steps in.
"The day she comes in for the biopsy, we are there in that room with her, to literally hold her hand and help her feel comfortable," Winter says. "We keep her family informed if they are in the waiting room. And then we help her get results the next day."
The usual time for pathology results is a week or more. At Baptist, they have cut that to 24 hours.
"We have such a dedicated pathology staff that most women get their biopsy results the next day," she says, "and that helps so much to allay their fears."
If the news is good, then Winter tells the patient to follow up in six months or a year. If it indicates cancer, "then we are there as her new best friend. We get her in contact with a doctor, set her up with a surgeon, give her lots of information, and stay in touch with her."
Winter sets up the weekly Multidisciplinary Breast Conferences, helping determine which patients need a thorough review from other specialists. That particular week, a woman recently had a double mastectomy, and the question was what would be the best follow-up treatment.
"Many people think, if you've taken the breast, you've gotten the cancer," she explains. "But cancer can start from a single cell. The surgeon gets all he can see, but you still need more treatment." The group determined a round of aggressive chemotherapy would keep any new cancer in check for that particular patient. Her physician called her that day with the news, and Winter will follow up to see how she is responding.
Winter also helps educate the public by conducting health fairs and speaking to area schools, corporations, and other groups about breast cancer. She even has a model of a human breast, so women can see for themselves how a lump feels.
"The incidence of breast cancer is down," says Winter. "We can attribute that to better detection methods, and to more women getting mammograms. When it is found in its earliest form, breast cancer has a 95 percent survival rate."
In her four-year tenure with Baptist, she estimates she has assisted more than 560 women get through what can, for many, be a terrifying ordeal. A mammogram can be uncomfortable, and anything involving a large needle can be scary. "Some people need us more than others. Some just say, 'I'm fine, tell me what's going on and I'm good,'" she says. "Others need a little more of the personal touch, somebody they can call and say, 'Here's what I'm feeling' or 'I don't understand this.'"
She especially remembers one patient who needed a biopsy but just didn't think she could go through with it. "I said, you've got a CD player. Just bring your favorite CD with you. So she brought Norah Jones and I sat there holding her hand while she listened to it."
The woman's biopsy was benign. When Winter followed up the good news with a phone call, the grateful patient told her, "I want to thank you. In the rest of your life, if you have to go through anything that scary, you call me, and I will be there for you ."
Women who have had good experiences are the hospital's best advocates, says Winter. "I tell them, the next time you meet a woman facing this, you tell them not to listen to the horror stories. Tell them it's not so bad."
Where Little Miracles Happen
Breast cancer rates may be improving, but other areas of health care aren't. A recent federal study reveals that almost one in eight babies is born prematurely — an increase of 30 percent over the past 20 years — and a report from the Institute of Medicine reveals that physicians are not sure why this is happening: "Doctors don't know the cause of most preterm births or how to prevent them, and have few good ways even to predict which women will go into preterm labor." Most of those "preemies" end up at The Med's Newborn Center, or at the Baptist Women's Hospital Newborn Intensive Care Unit, or NICU (pronounced "nick-you").
Any baby born within 37 weeks after conception is considered premature. That can cause all sorts of problems, but the most common involves their lungs.
Teresa Bentley is the NICU nurse manager. She explains that a premature baby's lungs "are like a new balloon that you blow up for the first time. The lining of their lungs sticks together because they haven't developed the hyaline membrane inside that keeps them inflated. Like a bubble stays open on its own? They just won't stay open."
Baptist, along with other newborn centers, uses a chemical called a surfactant — people don't like hearing this, but it's actually extracted from the lungs of cows and pigs — injected directly into the lungs to basically lubricate the lining, so breathing is easier.
That's critically important for premature babies, where the slightest effort can be life-threatening. In the NICU, babies are lined up in high-tech incubators called Giraffe OmniBeds — plexiglass capsules that monitor their breathing, heart rate, weight, and body temperature. The babies are completely concealed beneath thick quilted covers, because even the slightest sound or light can cause them to burn precious calories.
These $33,000 incubators can be heated to 100 degrees or more. "A baby's temperature should be the same as an adult's," says Bentley, "but their skin is not developed enough to retain their body heat. So they have to stay in the beds until they can."
For some of these babies, life in the NICU can extend for weeks, even months.
"Everything has to line up just right before they can go home," says Bentley. "That means they have to be heating their own body, and taking in all the calories they need, either from breast-feeding or bottle feeding."
A long stay in the hospital puts an enormous financial and emotional strain on any family. The NICU has two sleep rooms, which families can use so they can stay near their baby. There's also a hotel just across the street. "But a lot of families go back to work so they can then spend their maternity leave for the time when the baby finally comes home," says Bentley. "It's really hard, really stressful, but they get to know the other families in here too, and we get to know them pretty well."
One baby they got to know very well was Lucie Finley. Four months premature, she weighed just 26 ounces.
"If she had been born just one week earlier, she would have had no chance of survival," says her mother, Lawrence Bondurant. "There were many days when we didn't know if she was going to live. She had brain bleeds, a blod clot in her kidneys. It was just terrifying beyond belief."
The tiny girl was so fragile that Lawrence and her husband, Jeff Finley, weren't allowed to hold her for a month. "Their skin is so fragile that it hurts them," says Bondurant. "And it's definitely hard to bond with your baby when she has all these wires and tubes attached to her, and you have to wear surgical gloves, a mask, and a gown."
Lucie remained in the NICU for 97 days. "Our nurse, Carol Harber, is the only reason she is still alive," says Bondurant. "Lucie was always 'alarming' — she would stop breathing, or her heart rate would change — and the nurses took amazing care of her. They are just angels, watching those babies every moment of the day."
In a few months, Lucie will be 5 years old. She's in prekindergarten at Lausanne Collegiate School and seems to be doing fine. "You would never guess what she has been through," says her proud mother. "And she wouldn't be here if it weren't for the doctors and nurses she had."
Bentley has seen it all in the NICU, from the smallest baby ever born there — a 14-ounce girl ("from head to toe, she was smaller than a can of Coke") to that April evening in 2004 when a woman from Tipton County gave birth to quadruplets, an effort that required a team of 16 doctors and nurses. Each baby weighed just four pounds.
The 14-ounce girl survived, but — as do many babies born that early — has vision and neurological problems. The Tipton County quads are doing fine.
It would certainly be better if babies stayed in their mother's womb until they were fully developed, but it often doesn't work that way.
"Obviously, we are trying to get mama to wait," says Bentley, "but sometimes it's safer, for the mother and the baby, to be born than to wait."
As with so many areas of the Baptist Women's Hospital (see "Life Lessons" on page 77), a good part of the NICU's efforts involves education. Bondurant certainly remembers all the classes she took with her husband, and the bundles of materials they brought home with Lucie. "You learn how to read the monitors, how to do CPR, all sorts of things," she says. "You basically leave there with an honorary degree in medicine."
Bentley explains that the hospital wants the family to feel comfortable with their new baby: "We offer developmental classes so families — parents, siblings, even the grandparents — know how to interact with their babies when they bring them home. For example, a baby can't say what's wrong, so we teach the parents to know when a baby is giving a 'time out' signal."
For instance, if a parent is trying to check a baby's temperature, and the baby does what Bentley calls a "finger splay" — all fingers spread wide — that's a stress reaction. When an adult gets anxious, our hearts pound. But in a newborn, just the opposite happens. "If they stress, their heart rate slows down, and they can really have a bad situation really fast," says Bentley. So she shows parents how to recognize the danger signals — even teaching them CPR if it comes to that — and how to calm the baby by tucking it back into a fetal position. "That way their body seems to maintain itself much better. It's got its own support situation built right in."
Stress on a baby can have long-term effects. "Studies have shown that if you reduce stress as a neonate, they can actually do better in school later," says Bentley. "That makes all the nurses realize that this is very important. How we go about our treatment can have lifelong implications for that child, so we take it very seriously."
Bentley has been working in Baptist's neonatal unit — first at the main hospital and now here — for 20 years. She gets mixed reactions when she tells people her job.
"A lot of people think, oh, that's sad — all these sick little babies," she says. "But's that's just a small part of it. It's really an exciting place. It's where a lot of little miracles happen every day."